Iindidi / isifuba / isigulana / abantu abadala / unyango lwebele-pdq

Unyango lweCancer yamabele (yaBadala)

Ulwazi ngokubanzi malunga noMhlaza weSifuba

IINGONGOMA EZIPHAMBILI

• Umhlaza wamabele sisifo apho iiseli ezibi (zomhlaza) zeeseli zenzeka kwizicubu zesifuba.

• Imbali yosapho yomhlaza wamabele kunye nezinye izinto zonyusa umngcipheko womhlaza webele.

• Umhlaza webele ngamanye amaxesha ubangelwe kukutshintsha kwemfuza okuzuzwe njengelifa (utshintsho).

• Ukusetyenziswa kwamayeza athile kunye nezinye izinto kunciphisa umngcipheko womhlaza wamabele.

• Iimpawu zomhlaza wamabele zibandakanya iqhuma okanye utshintsho kwibele.

• Uvavanyo oluvavanya amabele lusetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa umhlaza webele.

• Ukuba umhlaza ufumanekile, kwenziwa iimvavanyo ukuze kufundwe iiseli zomhlaza.

• Izinto ezithile zichaphazela ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango.

Umhlaza wamabele sisifo apho iiseli ezibi (zomhlaza) zeeseli zenzeka kwizicubu zesifuba.

Isifuba senziwe ngamanqatha kunye nemibhobho. Isifuba ngasinye sinamacandelo ali-15 ukuya kwangama-20 abizwa ngokuba ngamalobes. I-lobe nganye inamacandelo amaninzi amancinci abizwa ngokuba zii-lobules. IiLobules ziphelela kwiibhalbhu ezincinci ezinokwenza ubisi. I-lobes, i-lobules, kunye ne-bulbs zidibene neetyhubhu ezincinci ezibizwa ngokuba yimibhobho.

I-Anatomy yebele labasetyhini. Ingono kunye ne-areola ziboniswa ngaphandle kwebele. Iimpawu ze-lymph, i-lobes, i-lobules, i-ducts kunye nezinye iindawo zangaphakathi zesifuba nazo zibonisiwe.

Isifuba ngasinye sineemithambo yegazi kunye nemithambo ye-lymph. Iinqanawa ze-lymph zithwala i-fluid engenambala, engenamanzi ebizwa ngokuba yi-lymph. Imikhumbi ye-lymph ithwala i-lymph phakathi kwe-lymph nodes. Ii-lymph node zincinci, zinemilo yeembotyi ezifumaneka emzimbeni wonke. Bacoca i-lymph kwaye bagcina iiseli ezimhlophe zegazi ezinceda ukulwa usulelo kunye nezifo. Amaqela ee-lymph node afunyanwa kufutshane nebele kwi-axilla (phantsi kwengalo), ngaphezulu kwekhola, nasesifubeni.

Uhlobo oluqhelekileyo lomhlaza webele yi-ductal carcinoma, eqala kwiiseli zemijelo. Umhlaza oqala kwi-lobes okanye i-lobules ubizwa ngokuba yi-lobular carcinoma kwaye uhlala ufumaneka kuwo omabini amabele kunezinye iintlobo zomhlaza wamabele. Umhlaza webele odumbisayo luhlobo oluqhelekileyo lomhlaza wamabele apho isifuba sifudumele, sibomvu, kwaye sidumbile.

Jonga ezi zishwankathelo zilandelayo ze- ngolwazi oluthe kratya malunga nomhlaza wamabele:

• Uthintelo loMhlaza webele

• Uvavanyo lomhlaza webele

• Unyango lomhlaza webele ngexesha lokukhulelwa

• Unyango lomhlaza webele lwamadoda

• Unyango loMhlaza webele waBantwana

Imbali yosapho yomhlaza wamabele kunye nezinye izinto zonyusa umngcipheko womhlaza webele.

Nantoni na eyandisa amathuba akho okufumana isifo ibizwa ngokuba yingozi. Ukuba nomngcipheko akuthethi ukuba uza kuba nomhlaza; ukungabinamngcipheko oko akuthethi ukuba awuzukufumana umhlaza. Thetha nogqirha wakho ukuba ucinga ukuba unokuba semngciphekweni womhlaza wamabele.

Izinto ezinobungozi kumhlaza wamabele zibandakanya oku kulandelayo:

• Imbali yobuqu yomhlaza wamabele ongenayo, i-ductal carcinoma in situ (DCIS), okanye i-lobular carcinoma in situ (LCIS).

• Imbali yobuqu yesifo sesifuba esingenabungozi.

• Imbali yosapho yomhlaza webele kwisalamane sokuqala (umama, intombi, okanye udade).

• Utshintsho oluzuze njengelifa kwi-BRCA1 okanye i-BRCA2 okanye ezinye iintlobo zofuzo ezonyusa umngcipheko womhlaza wamabele.

• Izicubu zamabele ezixineneyo kwimammogram.

• Ukubonakaliswa kwezicubu zebele kwi-estrogen eyenziwe ngumzimba. Oku kunokubangelwa:

• Ukuba sexesheni esemncinci.

• Ubudala ekuzalweni kokuqala okanye ongazange wazala.

• Ukuqala ukuya exesheni kamva.

• Ukuthatha iihormoni ezinje nge-estrogen edityaniswe neprogestin kwiimpawu zokuyeka ukuya exesheni.

• Unyango ngonyango lwe-radiation esifubeni / esifubeni.

• Ukusela utywala.

• Ukutyeba kakhulu.

Ukwaluphala yeyona nto iphambili kumngcipheko womhlaza. Ithuba lokufumana umhlaza liyonyuka njengokuba usiya ukhula.

Isixhobo sovavanyo lomngcipheko webele seNCI sisebenzisa imeko yomngcipheko wabasetyhini yokuqikelela umngcipheko womhlaza webele kule minyaka mihlanu izayo ukuya kuthi ga kuma-90 eminyaka. Esi sixhobo sikwi-intanethi senzelwe ukuba sisetyenziswe ngumboneleli wezempilo. Ngolwazi oluthe kratya malunga nomngcipheko webele lomhlaza webele, tsalela umnxeba ku-1-800-4-CANCER.

Umhlaza webele ngamanye amaxesha ubangelwe kukutshintsha kwemfuza okuzuzwe njengelifa (utshintsho).

Imfuza ekwiiseli ithwala ulwazi olufunyenwe kubazali bomntu. Umhlaza webele oselungelweni wenza malunga neepesenti ezintlanu ukuya kwishumi ekhulwini kuwo wonke umhlaza webele. Ezinye iintlobo zemfuza eziguqulweyo ezinxulumene nomhlaza wamabele zixhaphake kakhulu kumaqela athile.

Abasetyhini abaneenguqu ezithile zofuzo, ezinje nge-BRCA1 okanye i-BRCA2, banomngcipheko okhulayo womhlaza wamabele. Aba basetyhini banomngcipheko okhulayo womhlaza we-ovari, kwaye banokuba nomngcipheko owandayo wezinye iintlobo zomhlaza. Amadoda ane-gene eguqulweyo enxulumene nomhlaza webele nawo anengozi enkulu yomhlaza webele. Ngolwazi oluthe kratya, jonga isishwankathelo se- kunyango lweCancer Breast Cancer.

Kukho iimvavanyo ezinokuthi zibhaqe (zifumanise) ukutshintsha kwemfuza. Olu vavanyo lwemfuza ngamanye amaxesha lwenziwa kumalungu eentsapho ezinomngcipheko omkhulu womhlaza. Jonga isishwankathelo se- kwi-Genetics yeBele kunye neGynecologic Cancers ngolwazi oluthe kratya.

Ukusetyenziswa kwamayeza athile kunye nezinye izinto kunciphisa umngcipheko womhlaza wamabele.

Nantoni na eyanciphisa ithuba lakho lokufumana isifo ibizwa ngokuba yinto ekhuselayo.

Izinto zokukhusela umhlaza wamabele zibandakanya oku kulandelayo:

• Ukuthatha nakuphi na oku kulandelayo:

• Unyango lwehomoni ye-Estrogen kuphela emva kwesibeleko.

• Iimodyuli ezikhethiweyo ze-estrogen receptor (SERMs).

• Inhibitors yeAromatase.

• Ukuvezwa kancinci kwezicubu zamabele kwi-estrogen eyenziwe ngumzimba. Oku kunokuba sisiphumo se:

• Ukukhulelwa kwasekuqaleni.

• Ukuncancisa.

• Ukuzilolonga ngokwaneleyo.

• Ukuba nayiphi na kwezi nkqubo zilandelayo:

• I-Mastectomy ukunciphisa umngcipheko womhlaza.

• I-Oophorectomy yokunciphisa umngcipheko womhlaza.

• Ukupheliswa kweOvarian.

Iimpawu zomhlaza wamabele zibandakanya iqhuma okanye utshintsho kwibele.

Ezi kunye neminye imiqondiso inokubangelwa ngumhlaza wamabele okanye ngezinye iimeko. Jonga ugqirha wakho ukuba unayo nayiphi na kwezi zinto zilandelayo:

• Isigaxa okanye ukuqina ngaphakathi okanye kufutshane nebele okanye kwindawo engaphantsi.

• Utshintsho kubukhulu okanye imilo yebele.

• Ukuntywila okanye ukuntywila kulusu lwebele.

• Ingono yajika yangena ebeleni.

• Ulwelo, ngaphandle kobisi lwebele, oluvela kwingono, ingakumbi ukuba inegazi.

• Isikhumba esibomvu, esibomvu, okanye esidumbileyo esifubeni, kwingono, okanye kwi-areola (indawo emnyama yesikhumba ejikeleze ingono).

• Izidumbu ebeleni ezibonakala ngathi lulusu lweorenji, olubizwa ngokuba yipeau d'orange.

Uvavanyo oluvavanya amabele lusetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa umhlaza webele.

Jonga ugqirha wakho ukuba uphawula naluphi na utshintsho emabeleni akho. Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa:

• Uvavanyo lomzimba kunye nembali yezempilo: Uvavanyo lomzimba ukukhangela iimpawu zempilo ngokubanzi, kubandakanya nokujonga iimpawu zesifo, ezinje ngamaqhuma okanye nayiphi na into ebonakala ingaqhelekanga. Imbali yemikhwa yempilo yesigulana kunye nezifo zangaphambili kunye nonyango ziya kuthathwa.

• Uviwo lwebele lwezonyango (i-CBE): Uvavanyo lwebele ngugqirha okanye yingcali yezempilo. Ugqirha uya kuva ngononophelo amabele naphantsi kweengalo zamaqhuma okanye nayiphi na into ebonakala ingaqhelekanga.

• Isisombululo: X-reyi yebele.

Imigrafi. Isifuba sicinezelwe phakathi kwamacwecwe amabini. IX-reyi isetyenziselwa ukuthatha imifanekiso yeethishu zamabele.

• Uvavanyo lwe-Ultrasound: Inkqubo apho amaza esandi aphembelela amandla aphezulu (i-ultrasound) akhutshelwa ngaphandle kwizicubu zangaphakathi okanye kwizitho zokwenza i-echoes. Iingqungquthela zenza umfanekiso wezicubu zomzimba ezibizwa ngokuba yi-sonogram. Umfanekiso unokuprintwa ukuze ujongwe kamva.

• I-MRI (imaging resonance imaging): Inkqubo esebenzisa umazibuthe, amaza erediyo kunye nekhompyuter ukwenza uthotho lwemifanekiso eneenkcukacha zawo omabini amabele. Le nkqubo ikwabizwa ngokuba yimifanekiso yenyukliya yokujonga umfanekiso (i-NMRI).

• Izifundo ze-chemistry yegazi: Inkqubo apho kuvavanywa khona isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini ngamalungu kunye nezicubu zomzimba. Inani elingaqhelekanga (eliphezulu okanye elisezantsi kunesiqhelo) lwento elinokuba ngumqondiso wesifo.

• Biopsy: Ukususwa kweeseli okanye izicwili ukuze zijongwe ngemicroscope ngugqirha wezilwanyana ukujonga imiqondiso yomhlaza. Ukuba kufunyaniswe ukuba kukho isigaxa esifubeni, kungenziwa i-biopsy.

Zine iindidi zebhayopsy ezisetyenziselwa ukujonga umhlaza wamabele:

• I-biopsy ekhethekileyo: Ukususwa kwesigaxa sezicubu.

• I-incisional biopsy: Ukususwa kwenxalenye yesigaxa okanye isampulu yethishu.

• I-biopsy engundoqo: Ukususwa kwezicubu kusetyenziswa inaliti ebanzi.

• Fine-inaliti aspiration (FNA) biopsy: Ukususwa kwethishu okanye ulwelo, kusetyenziswa inaliti ebhityileyo.

Ukuba umhlaza ufumanekile, kwenziwa iimvavanyo ukuze kufundwe iiseli zomhlaza.

Izigqibo malunga nonyango olungcono zixhomekeke kwiziphumo zolu vavanyo. Iimvavanyo zinika ulwazi malunga:

• unokukhula ngokukhawuleza kangakanani umhlaza.

• kungenzeka njani ukuba umhlaza usasazeke emzimbeni wonke.

• unyango oluthile lunokusebenza kakuhle.

• kungenzeka njani ukuba umhlaza uphinde ubuye (ubuye).

Uvavanyo lubandakanya oku kulandelayo:

• Uvavanyo lwe-Estrogen kunye neprogesterone receptor: Uvavanyo lokulinganisa inani le-estrogen kunye neprogesterone (iihormone) receptors kwizicubu zomhlaza. Ukuba kukho ii-estrogen kunye neprogesterone receptors kunesiqhelo, umhlaza ubizwa ngokuba yi-estrogen kunye / okanye neprogesterone receptor eyakhayo. Olu hlobo lomhlaza webele lunokukhula ngokukhawuleza. Iziphumo zovavanyo zibonisa ukuba ngaba unyango lokuthintela i-estrogen kunye neprogesterone lunokumisa umhlaza ekukhuleni.

• Uhlobo lokukhula komntu kwisifo esikhulayo uhlobo lwe-2 receptor (HER2 / neu): Uvavanyo lwelebhu ukujonga ukuba zingaphi ii-HER2 / neu zofuzo ezikhoyo kwaye zingakanani iiprotein ze-HER2 / neu ezenziwe kwisampulu yethishu. Ukuba zininzi ii-HER2 / neu zofuzo okanye amanqanaba aphezulu e-HER2 / neu protein kunesiqhelo, umhlaza ubizwa ngokuba yi-HER2 / neu positive. Olu hlobo lomhlaza webele lunokukhula ngokukhawuleza kwaye kunokwenzeka ukuba lusasazeke kwamanye amalungu omzimba. Umhlaza unokunyangwa ngamachiza ajolise kwi-HER2 / neu protein, enje nge-trastuzumab kunye ne-pertuzumab.

• Uvavanyo lweMultigene: Uvavanyo ekufundwa kulo iisampulu zethishu ukujonga ukwenzeka kwezinto ezininzi ngexesha elinye. Olu vavanyo lunokunceda ukuqikelela ukuba umhlaza uya kusasazeka na kwamanye amalungu omzimba okanye uphinde ubuye (ubuye).

Zininzi iintlobo zeemvavanyo ezininzi. Ezi mvavanyo zilandelayo ziye zafundwa kuvavanyo lweklinikhi:

• I-Oncotype DX: Olu vavanyo luyanceda ukuqikelela ukuba ngaba umhlaza webele wamanqanaba okuqala yi-estrogen receptor elungileyo kunye ne-node negative iya kusasazeka kwamanye amalungu omzimba. Ukuba umngcipheko wokuba umhlaza uya kusasazeka uphezulu, i-chemotherapy inokunikwa ukunciphisa umngcipheko.

• Ushicilelo lweMamma: Uvavanyo lwaselebhu apho kujongwa khona ii-70 ezahlukeneyo zofuzo kumhlaza womhlaza webele wabasetyhini abanesifo somhlaza webele esaqala ukusasazeka kwii-lymph node okanye esisasazeke kwii-lymph node ezi-3 okanye ezimbalwa. Inqanaba lomsebenzi wale mfuza linceda ukuqikelela ukuba umhlaza webele uza kusasazeka kwamanye amalungu omzimba okanye ubuye. Ukuba uvavanyo lubonisa ukuba umngcipheko wokuba umhlaza uzosasazeka okanye ubuye uphezulu, ichemotherapy inokunikwa ukunciphisa umngcipheko.

Ngokusekwe kwezi mvavanyo, umhlaza wamabele uchazwa njengenye yezi ntlobo zilandelayo:

• IHormone receptor eyakhayo (i-estrogen kunye / okanye iprogesterone receptor elungileyo) okanye i-hormone receptor engeyiyo (i-estrogen kunye / okanye i-progesterone receptor).

• HER2 / neu HIV okanye HER2 / neu.

• Ukuphindaphindeka kathathu (i-estrogen receptor, iprogesterone receptor, kunye ne-HER2 / neu negative).

Olu lwazi lunceda ugqirha ukuba athathe isigqibo sokuba loluphi unyango oluza kusebenza kakuhle kumhlaza wakho.

Izinto ezithile zichaphazela ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango.

Ukuxela kwangaphambili kunye nokhetho lonyango luxhomekeke koku kulandelayo:

• Inqanaba lomhlaza (ubungakanani besisu kunye nokuba sikusifuba kuphela okanye sinwenwele kwii-lymph node okanye ezinye iindawo emzimbeni).

• Uhlobo lomhlaza wamabele.

• I-Estrogen receptor kunye nenqanaba le-progesterone receptor kwithishu yethumba.

• Ukukhula komntu kwindawo yohlobo lwe-2 receptor (HER2 / neu) kumanqanaba esiqhuma sethumba.

• Nokuba izicwili zethumba zinokuphindaphindeka kathathu (iiseli ezingenayo i-estrogen receptors, iiprogesterone receptors, okanye amanqanaba aphezulu e-HER2 / neu).

• Ukukhawuleza ngokukhawuleza kwethumba.

• Kusenokwenzeka ukuba libuye kwakhona ithumba (ubuye).

• Ubudala bomfazi, impilo ngokubanzi, kunye nenqanaba lokuya exesheni (nokuba ngaba ibhinqa lisesexesheni).

• Nokuba umhlaza sele ufumanekile okanye ubuyile kwakhona (buyela).

Amanqanaba omhlaza webele

IINGONGOMA EZIPHAMBILI

• Emva kokuba kufunyaniswe isifo somhlaza wamabele, kwenziwa iimvavanyo zokufumanisa ukuba ingaba iiseli zomhlaza zisasazekile esifubeni okanye kwamanye amalungu omzimba.

• Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

• Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

• Kumhlaza webele, inqanaba lisekwe kubungakanani kunye nendawo yethumba ephambili, ukusasazeka komhlaza kwii-lymph node ezikufuphi okanye kwamanye amalungu omzimba, inqanaba lesisu, nokuba ngaba kukho ii-biomarker ezithile ezikhoyo.

• Inkqubo ye-TNM isetyenziselwa ukuchaza ubungakanani besisu sokuqala kunye nokusasazeka komhlaza kwii-lymph node ezikufutshane okanye kwezinye iindawo zomzimba.

• Ithumba (T). Ubungakanani kunye nendawo yethumba.

• I-Lymph Node (N). Ubungakanani kunye nendawo ye-lymph node apho umhlaza usasazeke khona.

• Imetastasis (M). Ukusasazeka komhlaza kwamanye amalungu omzimba.

• Inkqubo yokuhlela isetyenziselwa ukuchaza ukuba ngokukhawuleza njani ukuba ithumba lesifuba likhule kwaye lisasazeke.

• Uvavanyo lwe-Biomarker lusetyenziselwa ukufumanisa ukuba ingaba iiseli zomhlaza webele zinee-receptors ezithile.

• Inkqubo ye-TNM, inkqubo yokuhlela, kunye nenqanaba le-biomarker zidityanisiwe ukufumana inqanaba lomhlaza wamabele.

• Thetha nogqirha wakho ukufumana ukuba leliphi inqanaba lomhlaza wamabele kwaye lisetyenziswa njani ukucwangcisa olona nyango lulungileyo kuwe.

• Unyango lomhlaza webele luxhomekeke kwinqanaba lesifo.

Emva kokuba kufunyaniswe isifo somhlaza wamabele, kwenziwa iimvavanyo zokufumanisa ukuba ingaba iiseli zomhlaza zisasazekile esifubeni okanye kwamanye amalungu omzimba.

Inkqubo esetyenziselwa ukufumanisa ukuba ngaba umhlaza usasazekile ngaphakathi kwebele okanye kwamanye amalungu omzimba kuthiwa yi-staging. Ulwazi oluqokelelwe kwinkqubo yokubeka inqanaba lesifo. Kubalulekile ukwazi inqanaba ukuze ucwangcise unyango. Iziphumo zezinye zeemvavanyo ezisetyenziselwa ukufumanisa umhlaza wamabele zikwasetyenziselwa ukuhambisa isifo. (Jonga icandelo loLwazi ngokubanzi.)

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa kwinkqubo yokuqokelela:

• I-Sentinel lymph node biopsy: Ukususwa kwe-sentinel lymph node ngexesha lotyando. I-lymph node ye-sentinel yindawo yokuqala ye-lymph kwiqela le-lymph node ukufumana i-lymphatic drainage kwi-tumor yokuqala. Yeyona nkovu node yokuqala ukuba umhlaza kunokwenzeka ukuba usasazeke ukusuka kwithumba lokuqala. Into ene-radioactive kunye / okanye idayi eblowu ifakwe kwisitofu kufutshane nethumba. Isixhobo okanye idayi ihamba ngee-lymph ducts ukuya kwii-lymph nodes. I-lymph node yokuqala yokufumana into okanye idayi isuswe. Ugqirha wezifo ujonga izicwili phantsi kwemicroscope ukukhangela iiseli zomhlaza. Ukuba iiseli zomhlaza azifumaneki, kusenokungabikho mfuneko yokususa ii-lymph node. Ngamanye amaxesha, i-lymph node ye-sentinel ifunyanwa ngaphezulu kweqela elinye lendawo.

• I-x-ray yesifuba: IX-reyi yamalungu namathambo ngaphakathi kwesifuba. IX-reyi luhlobo lwe-beam yamandla enokuhamba emzimbeni nakwifilimu, yenza umfanekiso weendawo ezingaphakathi komzimba.

• Ukuskena i-CT (ukuskena i-CAT): Inkqubo eyenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezithathwe kwii-engile ezahlukeneyo. Imifanekiso yenziwe yikhompyuter edityaniswe kumatshini we-x-ray. Idayi inokufakwa ngaphakathi emthanjeni okanye iginywe ukunceda amalungu okanye izicwili zibonise ngokucacileyo. Le nkqubo ikwabizwa ngokuba yi-computed tomography, ikhompyuter ye-tomography, okanye ikhompyuter ye-axial tomography.

• Ukuskena amathambo: Inkqubo yokujonga ukuba ngaba kukho iiseli ezahlula ngokukhawuleza, ezinje ngeeseli zomhlaza, emathanjeni. Inani elincinci kakhulu lezinto ezisasazeka ngemitha lifakwa emthanjeni kwaye lihamba ngokuhamba kwegazi. Izinto ezinemitha eqhumayo ziqokelela emathanjeni anomhlaza kwaye zifunyenwe siskena.

• Ukuskena i-PET (positron emission tomography scan) Inkqubo yokufumana iiseli zethumba ezinobungozi emzimbeni. Inani elincinci leswekile ene-radioactive (iswekile) itofelwe emthanjeni. Iskena se-PET sijikeleza ujikeleze umzimba kwaye senze umfanekiso wendawo esetyenziswa kuyo iswekile emzimbeni. Iiseli zethumba ezinobungozi zibonakala ziqaqambile emfanekisweni kuba ziyasebenza kwaye zithatha iswekile eninzi kuneseli eziqhelekileyo.

Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

Umhlaza unokusasazeka ngezicubu, inkqubo ye-lymph, kunye negazi:

• Izicubu. Umhlaza usasazeka ukusuka apho waqala ngokukhula waya kwiindawo ezikufuphi.

• Inkqubo yeLymph. Umhlaza usasazeka ukusuka apho waqala ngokungena kwinkqubo ye-lymph. Umhlaza uhamba ngemithambo ye-lymph ukuya kwamanye amalungu omzimba.

• Igazi. Umhlaza usasazeka ukusuka apho waqala ngokungena egazini. Umhlaza uhamba ngemithambo yegazi uye kwamanye amalungu omzimba.

Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

Xa umhlaza usasazeka kwelinye ilungu lomzimba, ubizwa ngokuba yi-metastasis. Iiseli zomhlaza ziyaphuma apho ziqale khona (ithumba lokuqala) kwaye zihamba ngenkqubo ye-lymph okanye igazi.

• Inkqubo yeLymph. Umhlaza ungena kwinkqubo ye-lymph, uhamba kwiinqanawa ze-lymph, kwaye wenze i-tumor (i-metastatic tumor) kwenye indawo yomzimba.

• Igazi. Umhlaza ungena egazini, uhambe kwimithambo yegazi, kwaye wenze ithumba (metastatic tumor) kwelinye ilungu lomzimba.

I-tumor ye-metastatic yinto efanayo yomhlaza njenge-tumor yokuqala. Umzekelo, ukuba umhlaza wamabele usasazeka uye emathanjeni, iiseli zomhlaza ezisethanjeni ziiseli zomhlaza wamabele. Esi sifo ngumhlaza webele we-metastatic, hayi umhlaza wethambo.

Kumhlaza webele, inqanaba lisekwe kubungakanani kunye nendawo yethumba ephambili, ukusasazeka komhlaza kwii-lymph node ezikufuphi okanye kwamanye amalungu omzimba, inqanaba lesisu, nokuba ngaba kukho ii-biomarker ezithile ezikhoyo.

Ukucwangcisa olona nyango lulungileyo kunye nokuqonda isifo sakho, kubalulekile ukuba wazi inqanaba lomhlaza wamabele.

Zintathu iintlobo zamaqela esigaba somhlaza wamabele:

• Inqanaba lesibhengezo seklinikhi lisetyenziswa kuqala ukunika inqanaba lazo zonke izigulana ngokusekwe kwimbali yezempilo, kuvavanyo lomzimba, kuvavanyo lokucinga (ukuba lwenziwe), kunye ne-biopsies. Inqanaba lokuchazwa kweKlinikhi lichazwa yinkqubo ye-TNM, inqanaba lesisu, kunye nenqanaba le-biomarker (ER, PR, HER2). Kwiklinikhi yokubeka, i-mammography okanye i-ultrasound isetyenziselwa ukujonga ii-lymph node zeempawu zomhlaza.

• I-Pathological Prognostic Stage isetyenziselwa izigulana ezenziwa unyango njengonyango lwabo lokuqala. Isigaba sePathological Prognostic Stage sisekwe kulo lonke ulwazi lweklinikhi, imeko ye-biomarker, kunye neziphumo zovavanyo lwelabhoratri ezivela kwizicubu zamabele kunye ne-lymph node ezisuswe ngexesha lotyando.

• I-Anatomic Stage isekwe kubungakanani kunye nokusasazeka komhlaza njengoko kuchaziwe yinkqubo ye-TNM. Inqanaba le-Anatomic lisetyenziswa kwiindawo zehlabathi apho uvavanyo lwe-biomarker alufumaneki. Ayisetyenziswa eUnited States.

Inkqubo ye-TNM isetyenziselwa ukuchaza ubungakanani besisu sokuqala kunye nokusasazeka komhlaza kwii-lymph node ezikufutshane okanye kwezinye iindawo zomzimba. Ngomhlaza wamabele, inkqubo ye-TNM ichaza ithumba ngolu hlobo lulandelayo:

Ithumba (T). Ubungakanani kunye nendawo yethumba.

Ubungakanani beethumba zihlala zilinganiswa ngeemilimitha (mm) okanye iisentimitha. Izinto eziqhelekileyo ezinokusetyenziselwa ukubonisa ubungakanani be-tumor kwi-mm zibandakanya: indawo ebukhali yepensile (1 mm), indawo entsha yekhrayoni (2 mm), ipeyinti ephezulu yepensile (5 mm), ipea (10 mm), a ipeanut (20 mm), kunye nekalika (50 mm).

• I-TX: Ithumba lokuqala alinakuvavanywa.

• I-T0: Akukho phawu lwesisu sokuqala ebeleni.

• I-Tis: iCarcinoma in situ. Zimbini iintlobo ze-carcinoma yebele ese-situ:

• I-Tis (DCIS): I-DCIS yimeko apho iiseli ezingaqhelekanga zifumaneka kuludwe lwendlela yobisi. Iiseli ezingaqhelekanga azisasazekanga ngaphandle kwendlela ukuya kwezinye izicwili esifubeni. Ngamanye amaxesha, i-DCIS inokuba ngumhlaza wamabele ongenayo onako ukusasazeka kwezinye izicwili. Ngeli xesha, akukho ndlela yokwazi ukuba zeziphi izilonda ezinokungenela.

• I-Tis (Isifo se-Paget): Isifo se-Paget sengono yimeko apho iiseli ezingaqhelekanga zifumaneka khona kwiiseli zolusu lwengono kwaye zinokusasazeka kwi-areola. Ayimiselwanga ngokwenkqubo ye-TNM. Ukuba isifo sePaget KUNYE nomhlaza webele ongenayo ukhona, inkqubo ye-TNM isetyenziselwa ukubeka umhlaza wamabele oselwayo.

• I-T1: I-tumor i-20 millimeters okanye encinci. Kukho ii-subtypes ezi-4 zethumba elixhomekeke kubungakanani bethumba:

• I-T1mi: I-tumor i-1 millimeter okanye encinci.

• I-T1a: Ithumba likhulu kune-1 millimeter kodwa alikho likhulu kuneemilimitha ezi-5.

• I-T1b: Ithumba likhulu kuneemilimitha ezi-5 kodwa alikho likhulu kuneemilimitha ezili-10.

• I-T1c: Ithumba likhulu kuneemilimitha ezili-10 kodwa alikho ngaphezulu kweemilimitha ezingama-20.

• I-T2: Ithumba likhulu kuneemilimitha ezingama-20 kodwa alikho ngaphezu kweemilimitha ezingama-50.

• I-T3: Ithumba likhulu kuneemilimitha ezingama-50.

• I-T4: I-tumor ichazwa njengenye yezi zinto zilandelayo:

• I-T4a: ithumba likhule laba ludonga lwesifuba.

• I-T4b: ithumba likhule laba lulusu-isilonda senziwe kumphezulu wolusu esifubeni, amaqhuqhuvana amancinci amathumba abunjwe kwisifuba esinye kunye nethumba lokuqala, kunye / okanye kukho ukudumba kolusu ebeleni. .

• I-T4c: ithumba likhule laba ludonga lwesifuba kunye nesikhumba.

• I-T4d: umhlaza wamabele odumbayo-isinye kwisithathu okanye ngaphezulu kwesikhumba esifubeni sibomvu kwaye sidumbile (sibizwa ngokuba yi-peau d'orange).

I-Lymph Node (N). Ubungakanani kunye nendawo ye-lymph node apho umhlaza usasazeke khona.

Xa ii-lymph node zisuswe ngotyando kwaye zifundwa phantsi kwemicroscope ngugqirha wezifo, isifo se-pathologic sisetyenziselwa ukuchaza ii-lymph node. Isigaba se-pathologic of lymph node sichazwe ngezantsi.

• I-NX: I-lymph node ayinakuvavanywa.

• I-N0: Akukho phawu lomhlaza kwii-lymph node, okanye amaqela amancinci eeseli zomhlaza angaphezulu kwe-0.2 millimeter kwii-lymph node.

• I-N1: Umhlaza uchazwa njengenye yezi zinto zilandelayo:

• I-N1mi: umhlaza usasazekile kwi-axillary (indawo ye-armpit) ye-lymph node kwaye inkulu kune-0.2 millimeters kodwa ayinkulu kune-2 millimeters.
• I-N1a: umhlaza usasazeke kwi-1 ukuya kwi-3 i-axillary lymph node kwaye umhlaza ubuncinci kwi-lymph node ezinkulu kune-2 millimeters.
• I-N1b: umhlaza usasazeke kwii-lymph node kufutshane nethambo lesifuba kwicala elifanayo lomzimba njenge-tumor yokuqala, kwaye umhlaza mkhulu kune-0.2 millimeters kwaye ufunyanwa yi-sentinel lymph node biopsy. Umhlaza awufumaneki kwii-lymph node ze-axillary.

• I-N1c: umhlaza usasazeke kwi-1 ukuya kwi-3 i-axillary lymph node kwaye umhlaza ubuncinci kwi-lymph node ukhulu kuneemilimitha ezi-2.

Umhlaza ukwafunyanwa yi-sentinel lymph node biopsy kwii-lymph node kufutshane nethambo lesifuba kwicala elifanayo lomzimba njenge-tumor yokuqala.

• I-N2: Umhlaza uchazwa njengenye yezi zinto zilandelayo:

• I-N2a: umhlaza usasazeke kwi-4 ukuya kwi-9 ye-axillary lymph node kwaye umhlaza ubuncinci kwi-lymph node ukhulu kuneemilimitha ezi-2.
• I-N2b: umhlaza usasazeke kwii-lymph node kufutshane nesifuba kwaye umhlaza ufunyanwa ngovavanyo lokucinga. Umhlaza awufumaneki kwii-axillary lymph node yi-sentinel lymph node biopsy okanye i-lymph node dissection.

• I-N3: Umhlaza uchazwa njengenye yezi zinto zilandelayo:

• I-N3a: umhlaza usasazeke kwi-10 okanye ngaphezulu kwe-lymph nodes kwaye umhlaza ubuncinci kwi-lymph node mkhulu kune-2 millimeters, okanye umhlaza usasazeke kwii-lymph node ezantsi kwe-collarbone.

• I-N3b: umhlaza usasazeke kwi-1 ukuya kwi-9 ye-axillary lymph node kwaye umhlaza ubuncinci kwi-lymph node ukhulu kuneemilimitha ezi-2. Umhlaza ukwasasazekile nakwindawo ezalukeleyo kufutshane nethambo lesifuba kwaye umhlaza ufunyanwa kuvavanyo lokucinga;

okanye

Umhlaza usasazeke kwi-4 ukuya kwi-9 ye-axillary lymph node kunye nomhlaza ubuncinci kwi-lymph node enye enkulu kune-2 millimeters. Umhlaza ukwasasazekile kwii-lymph node kufutshane nesifuba secala elinye kwicala lomzimba njenge-tumor yokuqala, kwaye umhlaza mkhulu kune-0.2 millimitha kwaye ufunyanwa yi-sentinel lymph node biopsy.

• I-N3c: umhlaza usasazekile kwii-lymph node ngaphezulu kwesangqa secala lomzimba kwicala elinye lomzimba njenge-tumor yokuqala.

Xa ii-lymph node zijongwa kusetyenziswa i-mammography okanye i-ultrasound, ibizwa ngokuba yinkqubo yezonyango. Ukuqwalaselwa kweklinikhi kwee-lymph node akuchazwa apha.

Imetastasis (M). Ukusasazeka komhlaza kwamanye amalungu omzimba.

• M0: Akukho mqondiso wokuba umhlaza usasazeke nakwamanye amalungu omzimba.

• I-M1: Umhlaza usasazeke kwamanye amalungu omzimba, ubukhulu becala amathambo, imiphunga, isibindi, okanye ingqondo. Ukuba umhlaza uye wasasazeka kwii-lymph node ezikude, umhlaza kwii-lymph node mkhulu kune-0.2 millimeters. Umhlaza ubizwa ngokuba ngumhlaza wamabele.

Inkqubo yokuhlela isetyenziselwa ukuchaza ukuba ngokukhawuleza njani ukuba ithumba lesifuba likhule kwaye lisasazeke.

Inkqubo yokuhlela ichaza ithumba ngokusekwe kwindlela engaqhelekanga ngayo iiseli zomhlaza kunye nezicubu ezijongeka phantsi kwemicroscope kunye nokuba iiseli zomhlaza zinokukhula ngokukhawuleza kwaye zisasazeke njani. Iiseli zomhlaza ezikumgangatho ophantsi zijongeka njengeeseli eziqhelekileyo kwaye zihlala zikhula kwaye zisasazeka ngokuthe chu kuneeseli zomhlaza ezikumgangatho ophezulu. Ukuchaza indlela ezingaqhelekanga ngayo iiseli zomhlaza kunye nezicubu, ugqirha wezifo uya kuvavanya ezi zinto zintathu zilandelayo:

• Zingaphi izihlunu zethumba ezinemibhobho eqhelekileyo yebele.

• Ubungakanani kunye nokumila kwe-nuclei kwiiseli zethumba.

• Zingaphi iiseli ezahlulayo ezikhoyo, oko kungumlinganiso wokuba iiseli zethumba zikhula ngokukhawuleza kwaye zahlule.

Kwimpawu nganye, ugqirha wezifo unikezela inqaku eli-1 ukuya kwele-3; inqaku lika "1" lithetha ukuba iiseli kunye nezicubu zethumba zikhangeleka zifana neeseli kunye nethishu, kwaye amanqaku ka "3" athetha ukuba iiseli kunye nethishu kujongeka njengokungaqhelekanga. Amanqaku enkalo nganye adityaniswa kunye ukufumana amanqaku apheleleyo phakathi kwe-3 kunye ne-9.

Amabakala amathathu anokwenzeka:

• Amanqaku ewonke e-3 ukuya kwi-5: i-G1 (inqanaba eliphantsi okanye lahlulwe kakuhle).

• Amanqaku ewonke ka-6 ukuya ku-7: i-G2 (iBanga eliPhakathi okanye umahluko ophakathi).

• Amanqaku ewonke ka-8 ukuya ku-9: i-G3 (inqanaba eliphezulu okanye umahluko omdaka).

Uvavanyo lwe-Biomarker lusetyenziselwa ukufumanisa ukuba ingaba iiseli zomhlaza webele zinee-receptors ezithile.

Iiseli zamabele ezisempilweni, kunye neeseli ezithile zomhlaza wamabele, zinee-receptors (ii-biomarkers) ezinamathela kwihomoni ye-estrogen kunye neprogesterone. Ezi hormone ziyafuneka kwiiseli ezisempilweni, kwaye ezinye iiseli zomhlaza wamabele, ukukhula kunye nokwahlulahlula. Ukujonga ezi biomarkers, iisampulu zethishu eneseli yomhlaza wamabele ziyasuswa ngexesha le-biopsy okanye utyando. Iisampulu ziyavavanywa elebhu ukubona ukuba iiseli zomhlaza wamabele zine-estrogen okanye i-progesterone receptors.

Olunye uhlobo lwe-receptor (i-biomarker) efumaneka kumphezulu wazo zonke iiseli zomhlaza wamabele kuthiwa yi-HER2. Ii-receptors ze-HER2 ziyafuneka ukuze iiseli zomhlaza wamabele zikhule kwaye zahlule.

Ngomhlaza webele, uvavanyo lwe-biomarker lubandakanya oku kulandelayo:

• I-Estrogen receptor (ER). Ukuba iiseli zomhlaza webele zinee-estrogen receptors, iiseli zomhlaza zibizwa ngokuba zi-ER positive (ER +). Ukuba iiseli zomhlaza wamabele azinayo i-estrogen receptors, iiseli zomhlaza zibizwa ngokuba yi-ER negative (ER-).

• Iprogesterone receptor (PR). Ukuba iiseli zomhlaza webele zinee-progesterone receptors, iiseli zomhlaza zibizwa ngokuba zi-PR positive (PR +). Ukuba iiseli zomhlaza wamabele azinazo ii-progesterone receptors, iiseli zomhlaza zibizwa ngokuba zi-PR negative (PR-).

• Uhlobo lokukhula komntu kwi-epidermal yohlobo lwe-2 receptor (HER2 / neu okanye i-HER2). Ukuba iiseli zomhlaza wamabele zinamanani amakhulu kunesiqhelo ze-HER2 receptors kumphezulu wazo, iiseli zomhlaza zibizwa ngokuba zi-HER2 positive (HER2 +). Ukuba iiseli zomhlaza wamabele zinesixa esiqhelekileyo se-HER2 kumphezulu wazo, iiseli zomhlaza zibizwa ngokuba yi-HER2 negative (HER2-). Umhlaza webele we-HER2 + kunokwenzeka ukuba ukhule kwaye wahlule ngokukhawuleza kune-HER2- umhlaza webele.

Ngamanye amaxesha iiseli zomhlaza wamabele ziya kuchazwa njengeziphindwe kathathu ezimbi okanye zibe zintathu ezilungileyo.

• Ukuphindaphindeka kathathu. Ukuba iiseli zomhlaza wamabele azinayo i-estrogen receptors, iiprogesterone receptors, okanye inani elikhulu kunexabiso eliqhelekileyo le-HER2 receptors, iiseli zomhlaza zibizwa ngokuba zibi kathathu.

• Ukuphindaphindeka kathathu. Ukuba iiseli zomhlaza webele zinee-estrogen receptors, iiprogesterone receptors, kunye nenani elikhulu kuneliqhelekileyo le-HER2 receptors, iiseli zomhlaza zibizwa ngokuba zintathu ezilungileyo.

Kubalulekile ukwazi i-estrogen receptor, iprogesterone receptor, kunye nenqanaba le-HER2 receptor ukukhetha olona nyango lulungileyo. Kukho iziyobisi ezinokuthintela ii-receptors ekubeni zinamathele kwihomoni ye-estrogen kunye neprogesterone kwaye zinqande umhlaza ekukhuleni. Amanye amachiza anokusetyenziselwa ukuvimba ii-HER2 receptors kumphezulu weeseli zomhlaza wamabele kwaye umise umhlaza ekukhuleni.

Inkqubo ye-TNM, inkqubo yokuhlela, kunye nenqanaba le-biomarker zidityanisiwe ukufumana inqanaba lomhlaza wamabele.

Nayi imizekelo emi-3 edibanisa inkqubo ye-TNM, inkqubo yokuhlela, kunye nenqanaba le-biomarker yokufumana isigaba sePathological Prognostic somhlaza webele womfazi owenzelwe unyango lokuqala:

Ukuba ubukhulu be-tumor yi-30 millimeters (T2), ayizange isasazeke kwii-lymph nodes ezikufutshane (N0), ayisasazeki kwiindawo ezikude zomzimba (M0), kwaye:

• IBakala 1

• HER2 +

• ER-

• PR-

Umhlaza linqanaba IIA.

Ukuba ubukhulu be-tumor yi-53 millimeters (T3), sele isasazeke kwi-4 ukuya kwi-9 i-axillary lymph nodes (N2), ayizange isasazeke kwezinye iindawo zomzimba (M0), kwaye:

• IBakala 2

• HER2 +

• ER +

• PR-

Ithumba likwinqanaba IIIA.

Ukuba ubukhulu be-tumor yi-65 millimeters (T3), isasazeke kwi-3 i-axillary lymph nodes (N1a), isasazeka kwimiphunga (M1), kwaye:

• IBakala 1

• HER2 +

• ER-

• PR-

Umhlaza sisigaba IV (umhlaza webele we-metastatic).

Thetha nogqirha wakho ukufumana ukuba leliphi inqanaba lomhlaza wamabele kwaye lisetyenziswa njani ukucwangcisa olona nyango lulungileyo kuwe.

Emva kotyando, ugqirha wakho uya kufumana ingxelo ye-pathology echaza ubungakanani kunye nendawo yethumba lokuqala, ukusasazeka komhlaza kwii-lymph node ezikufuphi, inqanaba lesisu, nokuba ngaba kukho ii-biomarker ezithile ezikhoyo. Ingxelo yezifo kunye nezinye iziphumo zovavanyo zisetyenziselwa ukumisela inqanaba lomhlaza wamabele.

Kusenokwenzeka ukuba unemibuzo emininzi. Buza ugqirha wakho ukuba achaze indlela esetyenziswa ngayo isiteji ukugqiba ezona ndlela zintle zokunyanga umhlaza wakho nokuba kukho izilingo zeklinikhi ezinokuba zilungele wena.

Unyango lomhlaza webele luxhomekeke kwinqanaba lesifo.

Ukhetho lonyango lwe-ductal carcinoma in situ (DCIS), jonga iDuctal Carcinoma eSitu.

Kukhetho lonyango lwenqanaba I, inqanaba II, inqanaba IIIA, kunye nenqanaba elisebenzayo le-IIIC yomhlaza wamabele, jonga uMhlaza wamabele wakuqala, waseKhaya, okanye osebenzayo

Olukhetho kunyango lwe-IIIB, inqanaba lesibini le-IIIC elingenakusebenziseka, kunye nomhlaza webele wokudumba, jonga uMhlaza weSifuba esiPhucukileyo.

Kukhetho lonyango lomhlaza obuye wabuya kufutshane nendawo eqale kuyo, jonga umhlaza webele ophindaphindiweyo webele.

Unyango olunokukhethwa kwinqanaba le-IV (metastatic) umhlaza webele okanye umhlaza webele ophindaphindileyo kwamanye amalungu omzimba, jonga umhlaza webele weMetastatic.

Ukudumba komhlaza webele

Kumhlaza wamabele odumbayo, umhlaza usasazekile kulusu lwebele kwaye ibele libukeka libomvu kwaye lidumbile kwaye liziva lifudumele. Ubomvu kunye nokufudumala kwenzeka ngenxa yokuba iiseli zomhlaza zivimba iinqanawa ze-lymph kwesikhumba. Ulusu lwebele lunokubonisa imbonakalo yedimpled ebizwa ngokuba yipeau d'orange (njengesikhumba seorenji). Kungangabikho zigaqa ebeleni ezinokuviwa. Umhlaza webele wokuvuvukala unokuba kwinqanaba IIIB, inqanaba IIIC, okanye inqanaba IV.

Umhlaza webele odumbisayo webele lasekhohlo elibonisa ipeau d'orange kunye nengono eguqulweyo.

Umhlaza webele ophindaphindiweyo

Umhlaza wamabele ophindaphindiweyo ngumhlaza oye waphinda (wabuya) emva kokuba unyangiwe. Umhlaza ungabuya ebeleni, kulusu lwebele, kudonga lwesifuba, okanye kwii-lymph node ezikufutshane.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

• Kukho iintlobo ezahlukeneyo zonyango kwizigulana ezinomhlaza wamabele.

• Iindidi ezintandathu zonyango zisetyenziswa:

• Ugqirha

• Unyango ngemitha

• Unyango ngamayeza

• Unyango lweHormone

• Unyango ekujoliswe kulo

• Unyango lwe-Immunotherapy

• Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

• Unyango lomhlaza webele lunokubangela iziphumo ebezingalindelekanga.

• Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi.

• Izigulana zinokungena kuvavanyo lweklinikhi ngaphambi, ngexesha, okanye emva kokuqala unyango lomhlaza.

• Iimvavanyo zokulandelela zisenokufuneka.

Kukho iintlobo ezahlukeneyo zonyango kwizigulana ezinomhlaza wamabele.

Iindidi ezahlukeneyo zonyango ziyafumaneka kwizigulana ezinomhlaza wamabele. Olunye unyango lusemgangathweni (unyango olusetyenziswayo ngoku), kwaye olunye luvavanywa kuvavanyo lweklinikhi. Uvavanyo lweklinikhi yonyango luphononongo olwenzelwe ukunceda ukuphucula unyango lwangoku okanye ukufumana ulwazi kunyango olutsha kwizigulana ezinomhlaza. Xa uvavanyo lwezonyango lubonisa ukuba unyango olutsha lungcono kunonyango oluqhelekileyo, unyango olutsha kunokuba lunyango olusemgangathweni. Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi. Olunye uvavanyo lwezonyango luvuleleke kuphela kwizigulana ezingaluqalanga unyango.

Iindidi ezintandathu zonyango zisetyenziswa:

Ugqirha

Uninzi lwezigulana ezinomhlaza wamabele zenziwa utyando ukuze kususwe umhlaza.

I-Sentinel lymph node biopsy kukususa i-sentinel lymph node ngexesha lotyando. I-lymph node ye-sentinel yindawo yokuqala ye-lymph kwiqela le-lymph node ukufumana i-lymphatic drainage kwi-tumor yokuqala. Yeyona nkovu node yokuqala ukuba umhlaza kunokwenzeka ukuba usasazeke ukusuka kwithumba lokuqala. Into ene-radioactive kunye / okanye idayi eblowu ifakwe kwisitofu kufutshane nethumba. Isixhobo okanye idayi ihamba ngee-lymph ducts ukuya kwii-lymph nodes. I-lymph node yokuqala yokufumana into okanye idayi isuswe. Ugqirha wezifo ujonga izicwili phantsi kwemicroscope ukukhangela iiseli zomhlaza. Ukuba iiseli zomhlaza azifumaneki, kusenokungabikho mfuneko yokususa ii-lymph node. Ngamanye amaxesha, i-lymph node ye-sentinel ifunyanwa ngaphezulu kweqela elinye lendawo. Emva kwe-sentinel lymph node biopsy, ugqirha uyalisusa ithumba esebenzisa utyando lokugcina amabele okanye lweMastectomy. Ukuba iiseli zomhlaza zifunyenwe, ii-lymph node ezininzi ziya kususwa ngendlela eyahlukileyo. Oku kubizwa ngokuba yi-lymph node dissection.

Iindidi zotyando zibandakanya oku kulandelayo:

• Utyando olugcina ibele lutyando lokususa umhlaza kunye nezicubu eziqhelekileyo ezijikelezileyo, kodwa hayi ibele ngokwalo. Inxalenye yodonga lwesifuba esifubeni lunokususwa kwakhona ukuba umhlaza ukufutshane nayo. Olu hlobo lotyando lunokubizwa ngokuba yi-lumpectomy, i-mastectomy engaphelelanga, i-segmental mastectomy, i-quadrantectomy, okanye utyando lokonga amabele.

Utyando olugcina amabele. Kususwe ithumba kunye nezinye izihlunu eziqhelekileyo, kodwa hayi ibele ngokwalo. Ezinye i-lymph nodes phantsi kwengalo zingasuswa. Inxalenye yodonga lwesifuba esifubeni lunokususwa kwakhona ukuba umhlaza ukufutshane nayo.

• Iyonke imastectomy: Utyando lokususa lonke ibele elinomhlaza. Le nkqubo ikwabizwa ngokuba yi-mastectomy elula. Ezinye zee-lymph node eziphantsi kwengalo zinokususwa kwaye zijongwe umhlaza. Oku kunokwenziwa ngaxeshanye notyando lwebele okanye emva. Oku kwenziwa ngokusikwa okwahlukileyo.

Iyonke (elula) yemastectomy. Umgca ochokoziweyo ubonisa apho lisuswe lonke ibele. Ezinye ii-lymph node phantsi kwengalo nazo zinokususwa.

• Uhlengahlengiso olukhulu lwe-mastectomy: Utyando lokususa lonke ibele elinomhlaza, uninzi lwee-lymph node phantsi kwengalo, ulungelelwaniso ngaphezulu kwezihlunu zesifuba, kwaye ngamanye amaxesha, yinxalenye yezihlunu zodonga lwesifuba.

Ilungiswe ngokugqibeleleyo imastectomy. Umgca ochokoziweyo ubonisa apho lisuswe lonke ibele kunye nezinye ii-lymph node. Inxalenye yemisipha yodonga lwesifuba nayo inokususwa.

I-Chemotherapy inokunikwa ngaphambi kotyando ukususa ithumba. Xa unikwe ngaphambi kotyando, ichemotherapy iya kunciphisa ithumba kwaye inciphise inani lezihlunu ekufuneka zisuswe ngexesha lotyando. Unyango olunikwa ngaphambi kotyando lubizwa ngokuba lunyango lwangaphambi kokusebenza okanye unyango lwe-neoadjuvant.

Emva kokuba ugqirha ewususile wonke umhlaza onokubonakala ngexesha lotyando, ezinye izigulana zinokunikwa unyango ngemitha, unyango ngamayeza, unyango ekujoliswe kulo, okanye unyango lwehomoni emva kotyando, ukubulala naziphi na iiseli zomhlaza ezisele. Unyango olunikezwe emva kotyando, ukunciphisa umngcipheko wokuba umhlaza uza kubuya, lubizwa ngokuba lunyango lwasemva kokusebenza okanye unyango lwe-adjuvant.

Ukuba isigulana siza kuba ne-mastectomy, ukwakhiwa kwakhona kwebele (utyando lokwakha kwakhona ubume besifuba emva kwe-mastectomy) kunokuqwalaselwa. Ukwakhiwa kwakhona kwesifuba kunokwenziwa ngexesha le-mastectomy okanye emva kwexesha elithile. Isifuba esenziwe ngokutsha singenziwa ngezicubu zomguli (ezingezizo ezesibeleko) okanye ngokusebenzisa izinto ezifakwe kwisaline okanye ijeli yesilicone. Phambi kokuba kwenziwe isigqibo sokumiliselwa, abaguli banokubiza iZiko lezoLawulo kunye nokuLawulwa kweziyobisi (i-FDA) iZiko lezixhobo kunye neMpilo yeRadiologic kwi-1-888-INFO-FDA (1-888-463-6332) okanye undwendwele iwebhusayithi ye-FDA ulwazi oluninzi malunga nokufakwa kwamabele.

Unyango ngemitha

Unyango ngemitha lunyango olusebenzisa amandla e-x-reyi okanye ezinye iintlobo zemitha yokubulala iiseli zomhlaza okanye ukuzigcina zikhula. Zimbini iintlobo zonyango lwe-radiation:

• Unyango lwangaphandle lwemitha lusebenzisa umatshini ngaphandle komzimba ukuthumela imitha kumhlaza.

• Unyango lwangaphakathi lwemitha lusebenzisa into enemitha ye-radio etywinwe kwiinaliti, iimbewu, iingcingo, okanye iicatheters ezibekwe ngqo okanye kufutshane nomhlaza.

Indlela unyango lwe-radiation olunikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo. Unyango lwangaphandle lwemitha lusetyenziselwa ukunyanga umhlaza wamabele. Unyango lwangaphakathi lwemitha kunye ne-strontium-89 (i-radionuclide) isetyenziselwa ukunciphisa iintlungu zethambo ezibangelwa ngumhlaza wamabele osasazeke waya emathanjeni. I-Strontium-89 itofwe emthanjeni kwaye iya kumphezulu wamathambo. Imitha ikhutshwa kwaye ibulala iiseli zomhlaza emathanjeni.

Unyango ngamayeza

I-Chemotherapy yonyango lomhlaza olusebenzisa iziyobisi ukunqanda ukukhula kweeseli zomhlaza, nokuba zibulale iiseli okanye uziyekise ekwahlukaneni. Xa i-chemotherapy ithathwa ngomlomo okanye ifakwe kwi-vein okanye kwimisipha, amachiza angena kwigazi kwaye anokufikelela kwiiseli zomhlaza kuwo wonke umzimba (systemic chemotherapy). Xa i-chemotherapy ibekwa ngqo kwi-cerebrospinal fluid, ilungu, okanye indawo yomzimba efana nesisu, iziyobisi zichaphazela kakhulu iiseli zomhlaza kwezo ndawo (chemotherapy yengingqi).

Indlela i-chemotherapy enikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo. I-chemotherapy yenkqubo isetyenziswa kunyango lomhlaza wamabele.

Jonga iziyobisi ezivunyiweyo zomhlaza webele ngolwazi oluthe kratya.

Unyango lweHormone

Unyango lweHormone lunyango lomhlaza olususa iincindi zamadlala okanye ibhlokhe isenzo sabo kwaye luyekise iiseli zomhlaza ekukhuleni. IiHormone zizinto ezenziwe ngamadlala emzimbeni kwaye zijikelezwa kwigazi. Ezinye iihormoni zinokubangela ukuba ezinye iintlobo zomhlaza zikhule. Ukuba iimvavanyo zibonisa ukuba iiseli zomhlaza zineendawo apho iihormone zinokuncamathisela (ii-receptors), iziyobisi, utyando, okanye unyango lwemitha lusetyenziselwa ukunciphisa ukuveliswa kwehomoni okanye ukubathintela ekusebenzeni. Ihomoni estrogen, eyenza ezinye i-cancer zomhlaza zikhule, yenziwa ikakhulu zii-ovari. Unyango lokumisa ama-ovari ekwenzeni i-estrogen kuthiwa yi-ovarian ablation.

Unyango lweHormone nge-tamoxifen luhlala lunikwa izigulana ezinomhlaza webele wasekuqaleni onokuthi ususwe ngotyando kunye nabo banesifo somhlaza webele (umhlaza osele usasazekile kwamanye amalungu omzimba). Unyango lweHormone nge-tamoxifen okanye ii-estrogens lunokusebenza kwiiseli kuwo wonke umzimba kwaye lunokunyusa ithuba lokuphuhlisa umhlaza we-endometrium. Abasetyhini abathatha i-tamoxifen kufuneka babe novavanyo lwe-pelvic minyaka le ukukhangela nayiphi na imiqondiso yomhlaza. Nakuphi na ukopha kwilungu lobufazi, ngaphandle kokopha exesheni, kufuneka kuxelwe kugqirha ngokukhawuleza.

Unyango lwehormone ene-luteinizing hormone-ekhulula i-hormone (LHRH) i-agonist inikwa abanye abantu besetyhini abasandula kufunyaniswa benomhlaza webele. I-LHRH i-agonists inciphisa i-estrogen yomzimba kunye neprogesterone.

Unyango lwehormone nge-aromatase inhibitor lunikwa abanye abantu besetyhini abanesifo se-hormone receptor esinomdlavuza webele. I-Aromatase inhibitors inciphisa i-estrogen yomzimba ngokuthintela i-enzyme ebizwa ngokuba yi-aromatase ekuguqukeni kwe-androgen kwi-estrogen. I-Anastrozole, i-letrozole, kunye ne-exemestane ziindidi ze-aromatase inhibitors.

Ukunyanga umhlaza webele wasekuqaleni onokususwa ngotyando, ezinye i-aromatase inhibitors zinokusetyenziswa njengonyango lwe-adjuvant endaweni ye-tamoxifen okanye emva kweminyaka emi-2 ukuya kwemi-3 yokusebenzisa i-tamoxifen. Unyango lomhlaza webele we-metastatic, aromatase inhibitors ziyavavanywa kuvavanyo lweklinikhi ukuzithelekisa nonyango lwehormone kunye ne-tamoxifen.

Kwabasetyhini abanomdlavuza webele we-hormone receptor, ubuncinci iminyaka emi-5 yonyango oluncedisayo lwe-hormone kunciphisa umngcipheko wokuba umhlaza uphinde ubuye (ubuye).

Ezinye iintlobo zonyango lwehomoni zibandakanya i-megestrol acetate okanye unyango lwe-anti-estrogen olufana nevestvestrant.

Jonga iziyobisi ezivunyiweyo zomhlaza webele ngolwazi oluthe kratya.

Unyango ekujoliswe kulo

Unyango ekujoliswe kulo luhlobo lonyango olusebenzisa iziyobisi okanye ezinye izinto ukuchonga nokuhlasela iiseli ezithile zomhlaza ngaphandle kokonakalisa iiseli eziqhelekileyo. Ama-antibodies e-monoclonal, i-tyrosine kinase inhibitors, i-cyclin-exhomekeke kwi-kinase inhibitors, ekujoliseni i-mammalian ye-rapamycin (mTOR) inhibitors, kunye ne-PARP inhibitors ziindlela zonyango ekujoliswe kuzo ezisetyenziselwa unyango lomhlaza webele.

Unyango lwe-monoclonal antibody yonyango lomhlaza olusebenzisa ii-antibodies ezenziwe elebhu, ukusuka kuhlobo olunye lweeseli zomzimba. Ezi antibodies zinokuchonga izinto ezikumhlaza iiseli okanye izinto eziqhelekileyo ezinokunceda iiseli zomhlaza zikhule. Amachiza omzimba ancamathele kwizinto kwaye abulale iiseli zomhlaza, athintele ukukhula kwazo, okanye azigcine zisasazeka. Iintsholongwane zeMonoclonal zinikezelwa ngokufakwa. Zingasetyenziselwa zodwa okanye ukuphatha iziyobisi, ityhefu, okanye izinto ezinemitha yeathom ngqo kwiiseli zomhlaza. Iintsholongwane zeMonoclonal zingasetyenziselwa ukudibanisa ne-chemotherapy njengonyango oluncedisayo.

Iindidi zonyango lwe-monoclonal antibody zibandakanya oku kulandelayo:

• I-Trastuzumab yi-monoclonal antibody ethintela iziphumo zokukhula kweprotein ye-HER2, ethumela imiqondiso yokukhula kwiiseli zomhlaza wamabele. Ingasetyenziselwa ezinye iindlela zonyango ukunyanga umhlaza webele we-HER2.

• I-Pertuzumab yi-monoclonal antibody enokuthi idityaniswe ne-trastuzumab kunye ne-chemotherapy ukunyanga umhlaza wamabele. Ingasetyenziselwa ukunyanga izigulana ezithile ezinomhlaza webele we-HER2 oqinisekileyo osasazeke (usasazeka kwamanye amalungu omzimba). Ingasetyenziselwa unyango lwe-neoadjuvant kwizigulane ezinomhlaza ophezulu, ovuthayo okanye umdlavuza webele. Inokusetyenziswa njengonyango olongezelelekileyo kwizigulana ezithile ezinomhlaza webele we-HER2.

• I-Ado-trastuzumab emtansine yintsholongwane emonoclonal enxulunyaniswe nesiyobisi somhlaza. Oku kubizwa ngokuba yi-anti-drug conjugate. Isetyenziselwa ukunyanga umhlaza webele we-HER2 osasazeke kwamanye amalungu omzimba okanye waphinda wabuya (buyela). Ikwasetyenziswa njengonyango olusebenzayo ukunyanga umhlaza webele we-HER2 kwizigulana ezinesifo esisele emva kotyando.

• I-Sacituzumab govitecan yintsholongwane ye-monoclonal antibody ephethe ichiza le-anticancer kwi-tumor. Oku kubizwa ngokuba yi-anti-drug conjugate. Kuyafundwa ukunyanga abasetyhini abanesifo somhlaza webele esiphindwe kathathu abafumene ubuncinci iirejimeni ezimbini zekhemotherapy zangaphambili.

I-Tyrosine kinase inhibitors ijolise kunyango lweziyobisi ezithintela imiqondiso efunekayo ekukhuleni kwamathumba. I-Tyrosine kinase inhibitors inokusetyenziswa kunye nezinye iziyobisi ezichaphazela umhlaza njengonyango olongezelelekileyo. I-Tyrosine kinase inhibitors ibandakanya oku kulandelayo:

• I-Lapatinib yi-tyrosine kinase inhibitor ethintela iziphumo ze-HER2 protein kunye nezinye iiproteni ngaphakathi kwiiseli zethumba. Ingasetyenziswa kunye namanye amachiza ukunyanga abaguli abanomhlaza webele we-HER2 oqhubekile emva konyango nge-trastuzumab.

• I-Neratinib yi-tyrosine kinase inhibitor ethintela iziphumo ze-HER2 protein kunye nezinye iiproteni ngaphakathi kwiiseli zethumba. Ingasetyenziselwa ukunyanga izigulana ezinesigaba sokuqala se-HER2 somhlaza webele emva konyango nge-trastuzumab.

I-cyclin-exhomekeke kwi-kinase inhibitors zijolise kunyango lwamachiza athintela iiprotein ezibizwa ngokuba zii-cyclin-exhomekeke kwii-kinase, ezibangela ukukhula kweeseli zomhlaza. I-cyclin-exhomekeke kwi-kinase inhibitors ibandakanya oku kulandelayo:

• I-Palbociclib yi-cyclin-exhomekeke kwi-kinase inhibitor esetyenziswe kunye ne-letrozole yeziyobisi ukunyanga umhlaza webele onomdla we-estrogen kunye ne-HER2 embi kwaye uye wasasazeka kwamanye amalungu omzimba. Isetyenziselwa abafazi abasemva kokuya exesheni abanomhlaza ongakhange unyangwe ngonyango lwehomoni. I-Palbociclib inokusetyenziswa kunye ne-fulvestrant kwabasetyhini abanesifo esiye sanda ngakumbi emva konyango kunyango lwehomoni.

• I-Ribociclib yi-cyclin-exhomekeke kwi-kinase inhibitor esetyenziswe nge-letrozole ukunyanga umhlaza webele onomdla we-hormone receptor kunye ne-HER2 negative kwaye ubuyile okanye usasazekile kwamanye amalungu omzimba. Isetyenziselwa abafazi abasemva kokuya exesheni abanomhlaza ongakhange unyangwe ngonyango lwehomoni. Ikwasetyenziswa kunye ne-fulvestrant kwabasetyhini abasemva kwe-postmenopausal abane-hormone receptor elungileyo kunye nomhlaza webele we-HER2 ongekhoyo osasazeke kwamanye amalungu omzimba okanye ophindaphindiweyo. Isetyenziswa nakwabasetyhini be-premenopausal abane-hormone receptor entle kunye nomhlaza webele we-HER2 ongekhoyo osasazeke kwamanye amalungu omzimba okanye ophindaphindiweyo.

• I-Abemaciclib yi-cyclin-exhomekeke kwi-kinase inhibitor esetyenziselwa ukunyanga i-hormone receptor elungileyo kunye nomhlaza webele we-HER2 ongalunganga oqhubele phambili okanye osasazeke kwamanye amalungu omzimba. Inokusetyenziswa yodwa okanye nezinye iziyobisi.

• I-Alpelisib sisixhobo se-kinase-exhomekeke kwi-kinase inhibitor esetyenziselwa isiyobisi esigcwalisayo ukunyanga i-hormone receptor elungileyo kunye nomhlaza webele we-HER2 ongalunganga otshintshe uhlobo oluthile kwaye uhambele phambili okanye usasazeke kwamanye amalungu omzimba. Isetyenziswa kubafazi abasemva kwemasopa abanomhlaza wamabele oye waba mandundu ngexesha okanye emva konyango kunyango lwehomoni.

Ukujoliswa kweMammalia kwe-rapamycin (mTOR) inhibitors kuthintela iprotein ebizwa ngokuba yi-mTOR, enokugcina iiseli zomhlaza zingakhuli kwaye kuthintele ukukhula kwemithambo yegazi emitsha ekufuneka ukuba amathumba akhule. I-mTOR inhibitors ibandakanya oku kulandelayo:

• I-Everolimus yi-mTOR inhibitor esetyenziswa kwabasetyhini abasemva kwe-postmenopausal abanomdlavuza webele we-hormone receptor onomdla ophethe i-HER2 kwaye awuzange ube bhetele ngolunye unyango.

I-PARP inhibitors luhlobo lonyango ekujoliswe kulo oluvimba ukulungiswa kwe-DNA kwaye kunokubangela ukuba iiseli zomhlaza zife. I-PARP inhibitors ibandakanya oku kulandelayo:

• I-Olaparib yi-PARP inhibitor esetyenziselwa ukunyanga izigulana ezinokutshintsha kwi-BRCA1 okanye i-BRCA2 yemfuza kunye nomhlaza webele we-HER2 ongekhoyo osasazeke kwamanye amalungu omzimba. Unyango lwe-PARP inhibitor luyafundwa kunyango lwezigulana ezinomhlaza wamabele ophindwe kathathu.

• I-Talazoparib yi-PARP inhibitor esetyenziselwa ukunyanga izigulana ezinokutshintsha kwi-BRCA1 okanye i-BRCA2 yemfuza kunye ne-HER2 yomhlaza webele ongalunganga oqhubele phambili ekuhlaleni okanye osasazeke kwamanye amalungu omzimba.

Jonga iziyobisi ezivunyiweyo zomhlaza webele ngolwazi oluthe kratya.

Unyango lwe-Immunotherapy

I-Immunotherapy lunyango olusebenzisa amajoni omzimba omzimba ukulwa nomhlaza. Izinto ezenziwe ngumzimba okanye ezenziwe elebhu zisetyenziselwa ukonyusa, ukuqondisa, okanye ukubuyisela ukhuseleko lwendalo lomzimba kumhlaza. Olu hlobo lonyango lomhlaza lukwabizwa ngokuba yi-biotherapy okanye unyango lwe-biologic.

Kukho iintlobo ezahlukeneyo ze-immunotherapy:

• Unyango lwe-immune checkpoint inhibitor: I-PD-1 yiprotein kumphezulu weeseli ze-T ezinceda ukugcina iimpendulo zomzimba zomzimba zijongiwe. Xa i-PD-1 incamathele kwenye iprotein ebizwa ngokuba yi-PDL-1 kwiseli yomhlaza, iyeka i-T cell ekubulaleni iseli yomhlaza. PD-1 inhibitors zinamathele kwi-PDL-1 kwaye zivumele iiseli ze-T ukuba zibulale iiseli zomhlaza. I-Atezolizumab yi-PD-1 inhibitor esetyenziselwa ukunyanga umhlaza wamabele osasazeke kwamanye amalungu omzimba.

Isithinteli sokujonga ukungasebenzi komzimba. Iiproteni zokujonga, ezinje nge-PD-L1 kwiiseli zethumba kunye ne-PD-1 kwiiseli ze-T, zinceda ukugcina iimpendulo ze-immune zitshekishwe. Ukubopha kwe-PD-L1 ukuya kwi-PD-1 kugcina iiseli ze-T ekubulaleni iiseli zethumba emzimbeni (iphaneli yasekhohlo). Ukuthintela ukubopha kwe-PD-L1 ukuya kwi-PD-1 nge-immune checkpoint inhibitor (anti-PD-L1 okanye anti-PD-1) ivumela iiseli ze-T ukuba zibulale iiseli zesisu (iphaneli esekunene).

Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

Ulwazi malunga novavanyo lweklinikhi luyafumaneka kwiwebhusayithi yeNCI.

Unyango lomhlaza webele lunokubangela iziphumo ebezingalindelekanga.

Ngolwazi malunga neziphumo ebezingalindelekanga eziqala ngexesha lonyango lomhlaza, jonga iphepha lethu Iziphumo ezingalunganga.

Olunye unyango lomhlaza webele lunokubangela iziphumo ebezingalindelekanga eziqhubekayo okanye ezibonakalayo kwiinyanga okanye kwiminyaka emva kokuba unyango luphelile. Oku kubizwa ngokuba ziziphumo ezifike emva kwexesha.

Iziphumo zamva zokunyanga ngemitha aziqhelekanga, kodwa zinokubandakanya:

• Ukudumba kwemiphunga emva konyango lwemitha ebeleni, ngakumbi xa ichemotherapy inikwa kwangaxeshanye.

• Ingalo ye-lymphedema, ngakumbi xa unyango lwe-radiation lunikezelwa emva kwe-lymph node dissection.

• Kwabasetyhini abangaphantsi kweminyaka engama-45 abafumana unyango ngemitha eludongeni lwesifuba emva kokubelekisa, kusenokubakho umngcipheko ophezulu wokuba nomhlaza wamabele kwelinye ibele.

Iziphumo zokugqibela zekhemotherapy zixhomekeka kwiziyobisi ezisetyenzisiweyo, kodwa zinokubandakanya:

• Ukumelwa yintliziyo.

• Amahlwili egazi.

• Ukuyeka ukuya exesheni.

• Umhlaza wesibini, njengeleukemia.

Iziphumo zamva kwexesha lonyango ekujoliswe kulo kunye ne-trastuzumab, i-lapatinib, okanye i-pertuzumab inokubandakanya:

• Iingxaki zentliziyo ezinje ngokusilela kwentliziyo.

Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi.

Kwezinye izigulana, ukuthatha inxaxheba kuvavanyo lweklinikhi kunokuba lolona khetho lonyango lufanelekileyo. Uvavanyo lwezonyango luyinxalenye yenkqubo yophando ngomhlaza. Uvavanyo lwezonyango luyenziwa ukufumanisa ukuba unyango lomhlaza olutsha lukhuselekile kwaye luyasebenza okanye lungcono kunonyango oluqhelekileyo.

Uninzi lonyango oluqhelekileyo lwanamhlanje lomhlaza lusekwe kuvavanyo lweklinikhi lwangaphambili. Izigulana ezithatha inxaxheba kuvavanyo lweklinikhi zingafumana unyango olusemgangathweni okanye zibe phakathi kwabokuqala ukufumana unyango olutsha.

Izigulana ezithatha inxaxheba kuvavanyo lweklinikhi zikwanceda ukuphucula indlela umhlaza oza kunyangwa ngayo kwixa elizayo. Nokuba uvavanyo lwezonyango alukhokeleli kunyango olusebenzayo, bahlala bephendula imibuzo ebalulekileyo kwaye bancedisa ukuqhubela phambili uphando.

Izigulana zinokungena kuvavanyo lweklinikhi ngaphambi, ngexesha, okanye emva kokuqala unyango lomhlaza.

Olunye uvavanyo lwezonyango lubandakanya kuphela izigulana ezingekafumani unyango. Olunye uvavanyo lokuvavanywa kunyango kwizigulana ezinomhlaza ongakhange ubengcono. Kukwakho nezilingo zeklinikhi ezivavanya iindlela ezintsha zokumisa umhlaza ekubuyeleni (ekubuyeni) okanye ukunciphisa iziphumo ebezingalindelekanga zonyango lomhlaza.

Uvavanyo lwezonyango lwenzeka kwiindawo ezininzi zelizwe. Ulwazi malunga novavanyo lweklinikhi oluxhaswe yi-NCI lunokufumaneka kwiphepha lewebhu le-NCI. Uvavanyo lwezonyango oluxhaswa yiminye imibutho lunokufumaneka kwiwebhusayithi yeClinicalTrials.gov.

Iimvavanyo zokulandelela zisenokufuneka.

Ezinye zeemvavanyo ezenziweyo ukufumanisa umhlaza okanye ukufumanisa inqanaba lomhlaza zinokuphindwa. Olunye uvavanyo luya kuphindwa ukuze kubonwe ukuba lusebenza njani unyango. Izigqibo malunga nokuqhubeka, ukutshintsha, okanye ukuyeka unyango zinokusekwa kwiziphumo zolu vavanyo.

Ezinye zeemvavanyo ziya kuqhubeka ukwenziwa amaxesha ngamaxesha emva kokuba unyango luphelile. Iziphumo zolu vavanyo zingabonisa ukuba imeko yakho itshintshile okanye ukuba umhlaza ubuyile (buyela). Olu vavanyo ngamanye amaxesha lubizwa ngokuba luvavanyo olulandelayo okanye ukuhlolwa.

Ukhetho kunyango lomhlaza webele

Kweli Candelo

• Ukuqala, ukuHanjiswa, okanye ukuSebenza komhlaza webele

• Ekuhlaleni okuPhucukileyo okanye okuDumbileyo Umhlaza webele

• Umhlaza webele ophindaphindiweyo

• Umhlaza webele weMastastatic

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Ukuqala, ukuHanjiswa, okanye ukuSebenza komhlaza webele

Unyango lomhlaza webele wokuqala, wasekhaya, okanye onokusebenza unokubandakanya oku kulandelayo:

Ugqirha

• Utyando lokugcina amabele kunye ne-sentinel lymph node biopsy. Ukuba umhlaza ufumaneka kwii-lymph node, i-lymph node dissection ingenziwa.

• Ilungiswe ngokugqibeleleyo imastectomy. Utyando lokwakhiwa kwakhona kwesifuba lunokwenziwa.

Unyango lwangemva kokusebenza

Kwabasetyhini abaye benza utyando olugcina amabele, unyango ngemitha lunikezwa lonke ibele ukunciphisa amathuba okuba umhlaza ubuye. Unyango ngemitha lunokunikwa ii-lymph node ezikule ndawo.

Kwabasetyhini abebenolungiso oluguquliweyo lwe-mastectomy, unyango ngemitha lunokunikwa ukunciphisa ithuba lokuba umhlaza ubuye ukuba ngaba kukho oku kulandelayo kuyinyani:

• Umhlaza wafunyanwa kwi-4 okanye ngaphezulu kwe-lymph node.

• Umhlaza ubusasazeke nakwizicubu ezijikeleze ii-lymph node.

• Ithumba lalilikhulu.

• Kukho ithumba elikufutshane okanye elisele kwithishu ekufuphi nemiphetho apho lalisuswe khona ithumba.

Unyango lwasemva kokusebenza

Unyango lwenkqubo kukusetyenziswa kwamachiza anokungena egazini kwaye afikelele kwiiseli zomhlaza kuwo wonke umzimba. Unyango lwasemva kokusebenza lunikezelwa ukunciphisa ithuba lokuba umhlaza ubuye emva kotyando ukususa ithumba.

Unyango lwenkqubo yokusebenza lwenziwa emva kokusebenza kuxhomekeke ekubeni:

• I-tumor i-receptor ye-hormone engalunganga okanye efanelekileyo.

• Ithumba yi-HER2 / neu negative okanye elungileyo.

• Ithumba liyi-receptor yehomoni engenayo kunye ne-HER2 / neu negative (kathathu).

• Ubungakanani bethumba.

Kwabafazi be-premenopausal abanehormone receptor isimila esihle, akusekho nyango lunokufuneka okanye unyango lwasemva kokusebenza lunokubandakanya:

• Unyango lweTamoxifen kunye okanye ngaphandle kwe-chemotherapy.

• Unyango lweTamoxifen kunye nonyango lokumisa okanye ukunciphisa i-estrogen yenziwa zii-ovari. Unyango lweziyobisi, utyando lokususa ii-ovari, okanye unyango lwemitha kwii-ovari zingasetyenziswa.

• Unyango lwe-Aromatase inhibitor kunye nonyango lokumisa okanye ukunciphisa i-estrogen yenziwa zii-ovari. Unyango lweziyobisi, utyando lokususa ii-ovari, okanye unyango lwemitha kwii-ovari zingasetyenziswa.

Kwabasetyhini be-postmenopausal abane-hormone receptor positive tumors, akusekho nyango lunokufuneka okanye unyango lwasemva kokusebenza lunokubandakanya:

• Unyango lwe-Aromatase inhibitor kunye okanye ngaphandle kwe-chemotherapy.

• I-Tamoxifen ilandelwa lunyango lwe-aromatase inhibitor, kunye okanye ngaphandle kwe-chemotherapy.

Kwabasetyhini abanehormone receptor isimila esibi, akusayi kubakho lunyango lunokufuneka okanye unyango lwasemva kokusebenza lunokubandakanya:

• Unyango ngamayeza.

Kwabasetyhini abane-HER2 / neu tumors ezimbi, unyango lwasemva kokusebenza lunokubandakanya:

• Unyango ngamayeza.

Kwabasetyhini abanezicubu ezincinci ze-HER2 / neu, kwaye akukho mhlaza kwii-lymph node, akusekho mfuneko yonyango. Ukuba kukho umhlaza kwii-lymph node, okanye ithumba likhulu, unyango lwasemva kokusebenza lunokubandakanya:

• I-Chemotherapy kunye nonyango ekujoliswe kulo (trastuzumab).

• Unyango lwehormone, olunje nge-tamoxifen okanye unyango lwe-aromatase inhibitor, yamathumba ekwanayo ne-hormone receptor elungileyo.

• Unyango lwe-Antibody-drug conjugate yonyango kunye ne-ado-trastuzumab emtansine.

Kwabasetyhini abane-hormone receptor encinci kunye ne-HER2 / neu tumors (engekho kathathu) kwaye akukho mhlaza kwi-lymph nodes, akusayi kubakho unyango. Ukuba kukho umhlaza kwii-lymph node okanye ithumba likhulu, unyango lwasemva kokusebenza lunokubandakanya:

• Unyango ngamayeza.

• Unyango ngemitha.

• Uvavanyo lweklinikhi yerejimeni entsha yonyango ngamayeza.

• Uvavanyo lweklinikhi yonyango lwe-PARP inhibitor.

Unyango lwangaphambi kokusebenza

Unyango lwenkqubo kukusetyenziswa kwamachiza anokungena egazini kwaye afikelele kwiiseli zomhlaza kuwo wonke umzimba. Unyango olusebenzayo lonyango lunikezelwa ukunciphisa ithumba ngaphambi kotyando.

Kwabasetyhini be-postmenopausal abane-hormone receptor positive tumors, unyango lwangaphambi kokusebenza lunokubandakanya:

• Unyango ngamayeza.

• Unyango lwehormone, olunjenge-tamoxifen okanye unyango lwe-aromatase inhibitor, kubafazi abangakwaziyo ukufumana ichemotherapy.

Kwabafazi be-premenopausal abanehormone receptor isimila esihle, unyango lwangaphambi kokusebenza lunokubandakanya:

• Uvavanyo lweklinikhi yonyango lwehomoni, njenge-tamoxifen okanye unyango lwe-aromatase inhibitor.

Kwabasetyhini abane-HER2 / neu tumors elungileyo, unyango lwangaphambi kokusebenza lunokubandakanya:

• I-Chemotherapy kunye nonyango ekujoliswe kulo (trastuzumab).

• Unyango ekujoliswe kulo (pertuzumab).

Kwabasetyhini abane-HER2 / neu tumors ezimbi okanye izicubu ezimbi ezintathu, unyango lwangaphambi kokusebenza lunokubandakanya:

• Unyango ngamayeza.

• Uvavanyo lweklinikhi yerejimeni entsha yonyango ngamayeza.

• Uvavanyo lweklinikhi yonyango lwe-monoclonal antibody.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

Ekuhlaleni okuPhucukileyo okanye okuDumbileyo Umhlaza webele

Unyango lomhlaza webele osele uqhubekile okanye odumbileyo ludibaniso lonyango olunokubandakanya oku kulandelayo:

• Utyando (utyando lolondolozo lwebele okanye isifo esipheleleyo se-mastectomy) kunye ne-lymph node dissection.

• I-Chemotherapy ngaphambi kunye / okanye emva kotyando.

• Unyango ngemitha emva kotyando.

• Unyango lwehormone emva kotyando lwamathumba anokwamkelwa kwe-estrogen okanye i-estrogen receptor ayaziwa.

• Uvavanyo lwezonyango kuvavanywa amachiza amatsha omhlaza, indibaniselwano yamachiza amatsha, kunye neendlela ezintsha zokunika unyango.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

Umhlaza webele ophindaphindiweyo

Unyango lomhlaza webele ophindaphindwayo (umhlaza obuyileyo emva konyango ebeleni, eludongeni lwesifuba, okanye kwii-lymph node ezikufuphi), unokubandakanya oku kulandelayo:

• Unyango ngamayeza.

• Unyango lweHormone lwamathumba afumana i-hormone receptor elungileyo.

• Unyango ngemitha.

• Ugqirha.

• Unyango ekujoliswe kulo (trastuzumab).

• Uvavanyo lweklinikhi yonyango olutsha.

Jonga icandelo loMhlaza webele leMastastatic ngolwazi malunga nokhetho kunyango lomhlaza wamabele osasazeke kwiindawo zomzimba ngaphandle kwebele, udonga lwesifuba, okanye iindawo ezikufutshane ze-lymph nodes.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

Umhlaza webele weMastastatic

Unyango olukhethwe ngumhlaza webele we-metastatic (umhlaza osasazeke kwiindawo ezikude zomzimba) unokubandakanya oku kulandelayo:

Unyango lweHormone

Kwabafazi be-postmenopausal abasandula kufunyaniswa benomhlaza webele we-metastatic onayo i-hormone receptor elungileyo okanye ukuba imeko ye-hormone receptor ayaziwa, unyango lunokubandakanya:

• Unyango lweTamoxifen.

• Unyango lwe-Aromatase inhibitor (anastrozole, letrozole, okanye exemestane). Ngamanye amaxesha unyango lwe-cyclin exhomekeke kunyango lwe-kinase inhibitor (palbociclib, ribociclib, abemaciclib, okanye alpelisib) inikwa kwakhona.

Kwabafazi be-premenopausal abasandula ukufumanisa ukuba banomdlavuza webele we-metastatic onayo i-hormone receptor elungileyo, unyango lunokubandakanya:

• I-Tamoxifen, i-agonist ye-LHRH, okanye zombini.

• Unyango oluxhomekeke kwi-cyclin kinase inhibitor (ribociclib).

Kwabasetyhini abanezilonda ezingenayo i-hormone receptor okanye i-hormone receptor engaziwayo, ngokusasazeka kwithambo okanye izicubu ezithambileyo kuphela, kwaye ngubani oye waphathwa nge-tamoxifen, unyango lunokubandakanya:

• Unyango lwe-Aromatase inhibitor.

• Olunye unyango lwehomoni olufana ne-megestrol acetate, i-estrogen okanye unyango lwe-androgen, okanye unyango lwe-anti-estrogen olunjenge-fulvestrant.

Unyango ekujoliswe kulo

Kwabasetyhini abanomdlavuza webele we-metastatic onayo i-hormone receptor elungileyo kwaye engaphendulanga kolunye unyango, ukhetho lunokubandakanya unyango ekujolise kulo olunjenge:

• I-Trastuzumab, lapatinib, pertuzumab, okanye mTOR inhibitors.

• Unyango lwe-Antibody-drug conjugate yonyango kunye ne-ado-trastuzumab emtansine.

• Unyango lwe-cyclin exhomekeke kunyango lwe-kinase inhibitor (palbociclib, ribociclib, okanye abemaciclib) enokudityaniswa nonyango lwehomoni.

Kwabasetyhini abanesifo somhlaza webele se-metastatic esine-HER2 / neu elungileyo, unyango lunokubandakanya:

• Unyango olujolise kuko njenge-trastuzumab, i-pertuzumab, i-ado-trastuzumab emtansine, okanye i-lapatinib.

Kubasetyhini abanomdlavuza webele we-metastatic ongu-HER2 ongekhoyo, kunye nokuguqulwa kwe-BRCA1 okanye i-BRCA2, kwaye ngubani oye waphathwa nge-chemotherapy, unyango lunokubandakanya:

• Unyango olujolise kwi-PARP inhibitor (olaparib okanye talazoparib).

Unyango ngamayeza

Kwabasetyhini abanesifo somhlaza webele se-metastatic esingamkeli i-hormone receptor, esingaphendulanga kunyango lwehomoni, sinwenwele kwamanye amalungu okanye sibangele iimpawu, unyango lunokubandakanya:

• Chemotherapy ngeyeza elinye okanye nangaphezulu.

I-Chemotherapy kunye ne-immunotherapy

Kwabasetyhini abanesifo somhlaza webele se-metastatic esingamkeli i-hormone kunye ne-HER2, unyango lunokubandakanya:

• I-Chemotherapy kunye ne-immunotherapy (atezolizumab).

Ugqirha

• Iyonke imastectomy yabasetyhini abanezilonda zamabele ezivulekileyo okanye ezibuhlungu. Unyango ngemitha lunokunikwa emva kotyando.

• Ugqirha lokususa umhlaza osasazeke waya kwingqondo okanye kumqolo. Unyango ngemitha lunokunikwa emva kotyando.

• Utyando lokususa umhlaza onwenwele emiphungeni.

• Ugqirha ukulungisa okanye ukunceda ukuxhasa amathambo abuthathaka okanye aphukileyo. Unyango ngemitha lunokunikwa emva kotyando.

• Utyando lokususa ulwelo oluqokelelene kwimiphunga okanye entliziyweni.

Unyango ngemitha

• Ukunyanga ngemitha emathanjeni, kwingqondo, kwintambo yomqolo, ebeleni, okanye eludongeni lwesifuba ukunciphisa iimpawu kunye nokuphucula umgangatho wobomi.

• I-Strontium-89 (i-radionuclide) yokuphelisa iintlungu zomhlaza osasazeke waya kumathambo kuwo wonke umzimba.

Olunye ukhetho lonyango

Olunye ukhetho lonyango lomhlaza webele we-metastatic lubandakanya:

• Unyango lweziyobisi nge-bisphosphonates okanye i-denosumab ukunciphisa isifo samathambo kunye nentlungu xa umhlaza usasazekile kwithambo. (Jonga isishwankathelo se kubuhlungu beCancer ngolwazi oluthe kratya malunga ne-bisphosphonates.)

• Uvavanyo lweklinikhi yonyango lweedosi ephezulu kunye nokufakwa kweseli.

• Uvavanyo lweklinikhi ye-anti-drug conjugate (sacituzumab).

• Uvavanyo lwezonyango kuvavanywa amachiza amatsha omhlaza, indibaniselwano yamachiza amatsha, kunye neendlela ezintsha zokunika unyango.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

Iinketho zonyango lweDuctal Carcinoma In Situ (DCIS)

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Unyango lwe-ductal carcinoma in situ inokubandakanya oku kulandelayo:

• Utyando olugcina amabele kunye nonyango lwemitha, kunye okanye ngaphandle kwe-tamoxifen.

• Iyonke imastectomy kunye okanye ngaphandle kwe-tamoxifen. Unyango ngemitha lunokunikwa.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

Ukufunda ngakumbi ngoMhlaza weSifuba

Ngolwazi oluthe kratya kwiZiko loMhlaza weSizwe malunga nomhlaza webele, jonga oku kulandelayo:

• Umhlaza webele iphepha lasekhaya

• Ukhetho lotyando lwabasetyhini abane-DCIS okanye umhlaza webele

• Ugqirha ukunciphisa umngcipheko womhlaza webele

• Ukwakhiwa kwakhona kwebele emva kweMastectomy

• I-Sentinel Lymph yeNode Biopsy

• IiDense Breast: Iimpendulo zemibuzo edla ngokubuzwa

• Iziyobisi ezivunyiweyo kuMhlaza weSifuba

• Unyango lweHormone loMhlaza weSifuba

• Iithagethi zoMhlaza ezijolise kuko

• Ukudumba komhlaza webele

• Utshintsho lwe-BRCA: Umngcipheko woMhlaza kunye novavanyo lweMfuzo

• Uvavanyo lweMfuzo kwii-Syndromes eziSebenzayo zoMhlaza

Ngolwazi lomhlaza ngokubanzi kunye nezinye izixhobo ezivela kwiNational Cancer Institute, jonga oku kulandelayo:

• Malunga noMhlaza

• Ukuqokelela

• I-Chemotherapy kunye nawe: Inkxaso yabantu abanomdlavuza

• Unyango ngemitha kunye nawe: Inkxaso yabantu abanomhlaza

• Ukujamelana noMhlaza

• Imibuzo yokubuza ugqirha wakho malunga neCancer

• Abasindileyo kunye nabaNonopheli